U. professors comment on Texas Court ruling on Affordable Care Act

On Sept. 7, District Judge Reed O’Connor made two rulings in Texas that may significantly change the Affordable Care Act (ACA).

The first decision by the district judge found that the task force that helps decide federal health insurance mandates is unconstitutional. Additionally, he ruled that private insurers do not have to cover the pre-exposure prophylaxis (PrEP) medication, which is used to mitigate the spread of HIV and is a current requirement under the ACA.

Elenore Wade, assistant professor of law at the Rutgers Law School—Camden, said the rulings are not finalized yet, and if they go into effect, they would only apply to the judge’s district in Texas.

“For example, let's say you live in Missouri. This ruling has no force there because it only applies in places where this particular district court in Texas has jurisdiction,” she said. “That doesn't mean it wouldn't serve as a model potentially for other lawsuits to be brought in most other areas and those other federal courts, but as of now, even this particular judge's ruling would not take effect in other parts of the country.”

Wade also said the federal government would likely appeal the Judge’s ruling, and it could take time before the court’s decision goes into effect.

Wade also said the court’s ruling is based on an expanded definition of the Religious Freedom Restoration Act, which was initially made to protect individuals practicing private religious acts from federal laws. Though the courts have expanded it over time to apply to more broad circumstances that can impact the public more generally, she said.

The ruling came after six individuals and two businesses filed suit against the secretaries of the Department for Health and Human Services, Labor and the Treasury for their part in upholding the federal preventive care requirements.

When the ACA went into law in March 2010, it required most private health insurance providers to include screening and counseling for STDs. In 2019, PrEP was added to the list, and private insurers became required to cover the drug.

Wade said that the individuals who recommended adding the medication are members of the Preventive Services Task Force, a group of volunteer medical experts that aid the government in deciding what things should be federally mandated to be covered by the ACA.

Wade also said the court found that, due to the power the task force has, the appointment process of its members violates the appointments clause of the Constitution, as it was not confirmed by high-level cabinet members because the government did not deem them at the level requiring this process.

This decision could impact other preventive items federally required to be covered by health insurance companies and restrict or eliminate their power, but Wade said this can be avoided if President Joseph R. Biden Jr. signs off on appointing the task force members.

Perry Halkitis, dean of the School of Public Health, said the drug has been a beneficial tool in slowing the AIDS epidemic in the U.S.

The Judge’s ruling could also lead to more infections and elongate the epidemic for decades, resulting in more people needing treatment and more extensive pressure on the economy, Halkitis said.

“By decreasing the incidence of HIV, the number of people who require lifelong treatment also goes down, which puts less of a burden on our society economically and in terms of the health of populations,” Halkitis said. 

He also said the ruling is another example of the breakdown between church and state and leads to an erosion of public health, and that the judge’s ruling is misinformed or misguided.

Yen-Tyng Chen, an assistant professor at the Bloustein School of Planning and Public Policy, said that if the ACA-required coverage of PrEP ended, it would worsen existing disparities in health coverage.

“When taking out the ACA protection on PrEP, we are creating an injustice, immoral and (unsustainable) environment that worsens HIV disparity and pulls ... society from the goal of eliminating HIV," Chen said.